SEPTEMBER 1998

NUMBER ONE

Debate Over Short-Course AZT

AMONG THE MOST ENCOURAGING BUT CONTROVERSIAL news reported at the World AIDS Conference in Geneva concerns the use of "short-course" AZT to prevent maternal transmission of HIV. Recent U.S. government-sponsored studies in Thailand show that a one-month regimen of oral AZT given to women in the last month of pregnancy reduced HIV vertical transmission by 50 percent, at a reduced drug cost of $50 per patient. With 1,600 HIV-positive infants born every day-most in the developing world-the findings could have a major impact on pediatric HIV.

In response, the U.N., in cooperation with AZT's manufacturer, Glaxo Wellcome, has launched a pilot program that will offer short-course AZT to 30,000 pregnant women in 11 countries at the discounted price. While many have strongly applauded the move, some AIDS activists have denounced it as a short-sighted step, one driven more by Glaxo Wellcome's desire to market AZT to the developing world than by the health needs of the women living there. Short-course AZT, charge activists from the Paris chapter of ACT UP, only provides treatment to a woman during pregnancy and not afterward. While the U.N. program may protect infants from getting HIV, it's likely to produce more orphans in the long run after their mothers die, say critics.

They point out that AZT monotherapy has been linked with AZT resistance, and they worry about the longer-term effects of the short-course regimen. "We want to limit the spread of the epidemic but we think…it is a wrong and cheap choice," says Marie de Cenival of ACT UP/Paris. "It is not going to strengthen the health system in Africa."